Cosmetic Surgery: Promises and Pitfalls™

Breast Augmentation Surgery: A Procedure with More than 40 Years of Satisfactory Results

 
Breast augmentation is the enlargement of the female breast and is one of the most commonly performed cosmetic surgical procedures. It is done to improve body proportions and self-image. Though generally a very safe procedure with a high level of patient satisfaction, a woman considering breast augmentation should carefully consider the various options and potential risks of the procedure that may have lifelong implications.

Though the concept of placement of an implant to enlarge the breast may seem simple, there are many differences in opinion as to which of the following variables will produce the best result (most attractive, least potential for complication, etc.). One should understand that there is no standard breast augmentation operation. Each surgeon has their own opinion and patients should leave most of the decisions the surgeon. One should select the surgeon they trust and feel most comfortable with and allow them to use their judgment and experience to guide you.

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These pages on our website have other, related information related to breast augmentation:


 

PROMISES

Breast augmentation accomplishes an enlargement and enhancement of the female breasts to improve body proportions and patient's self-image. This is a procedure that has been done for more than 40 years with a very high level of patient satisfaction. However, when considering breast augmentation, the potential problems or pitfalls must be factored into one's decision.
 

PITFALLS

  • Selecting a Surgeon: Because any physician can represent himself/herself as a plastic or cosmetic surgeon and can do this procedure in an office facility, a patient should always check the surgeon's credentials. (See Promises and Pitfalls: Credentials.)
  • Techniques and Results Widely Vary: Though simple in concept, there are many specifics in technique that vary from surgeon to surgeon. A patient should not approach the decision about where to have this surgery as one would shop for a household service or product. This is a professional service that varies significantly from surgeon to surgeon.
  • Goals: A patient should have a clear concept of exactly what she would like to accomplish with surgery, and be able to express these goals to the surgeon. She should spend time with the surgeon, understanding his/her technique, goals and opinions. It is important that the surgeon determine whether the patient's goals are realistic. This discussion should be the responsibility of the surgeon, not an assistant.
  • Breast Sagging: Breast implants alone cannot be expected to correct significant breast sagging. It is a mistake in most cases to place large implants to fill a sagging breast. This can cause unnatural and aesthetically displeasing appearances that can be difficult to repair.
  • Risks: Although serious complications are rare, this is a real surgical procedure with all the potential risk of any surgery. Secondary procedures may be indicated in approximately 5-20% of patients undergoing breast augmentation. In order to be able to anticipate future expenses, the patient should be advised of her financial responsibility of the surgeon and that of the patient for any secondary surgery required.
  • The Consultation: It is important to approach a consultation with an open mind. The research a potential patient does is helpful; however, although there is a lot of information available in books, on the Internet, etc.and it can be very difficult for the average individual to separate marketing hype and opinions from fact. The only way to find out specific information is in a personal consultation.
  • Surgical Judgment: The responsibility of the surgeon goes way beyond the role of a surgical technician. The surgeon is expected to exercise judgment in recommending, planning and carrying out a surgical procedure. This judgment is the result of training and experience, and is the reason for choosing a surgeon certified by the American Board of Plastic Surgery. (See Promises and Pitfalls: Credentials.)

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OUR APPROACH

Our goal is quality and long-term results -- a soft, natural appearance with an appropriate size for the individual patient.

  • Anesthesia type depends on patient's health considerations but is otherwise the patient's choice. Local anesthesia and twilight sleep are often used for breast augmentation, providing safe, effective anesthesia and shorter recovery with less postoperative nausea and vomiting. However, the surgeon or patient may select general anesthesia as well. (See Promises and Pitfalls: Anesthesia.)
  • Location of surgery is also a choice of the patient. We provide surgical care in a variety of facilities including major hospitals, outpatient surgery centers and in our office-operating suite. Our office surgical suite is accredited by the American Association for the Accreditation of Ambulatory Surgical Facilities (AAAASF). (See Promises and Pitfalls: Office Surgery.)
  • Specific surgical technique varies with individual patient, and is determined and explained at the initial consultation. Consultation is with the surgeon who spends adequate time with the patient to explain specifics of physical finding, recommendations and surgical plan.
  • Implants used depends on the particular needs and request of the individual patient. Saline filled implants can be put in though a small incision, which is a factor when the peri-areolar incision is used. These are very safe and effective implants and are an option for patients to consider. Silicone implants have recently (January 2007) been released for general use and provide another choice for patients to consider. These implants are safe and effective and result in a softer feeling breast. A slightly larger incision is required (usually under the breast) and these implants are slightly more expensive than the saline implants. Both saline and silicone implants usually result in very satisfactory results. (See Promises and Pitfalls: Breast Implants.)
  • Suction drains are often used. Small drains are used to minimize fluid accumulation thereby preventing swelling and pain in the early postoperative period. These drains effectively minimize early distortion of the appearance of the breasts -- the immediate appearance of the breasts similar to the long-term appearance.
  • Activity after surgery is generally a rapid return to normal activities. We instruct our patients to resume normal activities as soon as they are able to do so comfortably. Though most patients are comfortable and get back to routine activities very soon after surgery. Some patients, of course, are slower in their recovery.
     

More About Post-Surgery Drains

When drains are not used breasts are swollen and very full in the upper breast region. Patients are told "Implants will drop." This is actually swelling from fluid in the space around the implant. The "dropping" or return to a relatively normal appearance occurs after several weeks as the fluid is absorbed by the body.

In our experience, the use of drains has been very beneficial to our patients:

  • less pain in the early postoperative period
  • minimal distortion of the appearance of the breasts early after surgery
  • no need for tight pressure dressing which often adds to the pain
  • speed convalescent period
  • reduce the incidence of capsular contracture with the result of softer more natural appearing and feeling breasts.

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Before and After Pictures

We have resisted the marketing pressure to feature a gallery of before and after pictures on our website. We are very proud of our results, but have had strong ethical reservations featuring such a gallery. The following considerations have influenced our opinions and hence our website:

  • Patient confidentiality: it seems unethical or at a minimum, insensitive, to a female patient to publish her nude pictures on the internet for the world to see. Would you want your pictures on the internet?
  • Patient selection: any savvy consumer must assume that only the best results are exhibited in a marketing website.
  • Picture selection: certainly the most favorable views are exhibited.
  • Photos are two-dimensional: what looks good may feel firm and abnormal.
  • Each patient is unique; what is shown in before and after pictures represents the results in that particular patient and has little bearing on any future patients.
  • Marketing is the primary value of before and after pictures exhibited on a surgeons website. Without dialog between patient and surgeon, viewing pictures has minimal educational value. While we hope our website has some marketing impact, we have attempted to provide source for factual information for potential cosmetic surgery patients.

The best way to find out specific information that is pertinent to you is in a consultation with a surgeon certified by the American Board of Plastic Surgery. Several consultations are often helpful for elective surgery such as breast augmentation.

In our consultations, our surgeons (not an assistant) show and discuss before and after pictures with potential patients. We are happy to show the quality of our results to prospective patients. The intent of showing photos is educational: to illustrate key points about the procedure and results and, in fact, less than ideal results are also shown to illustrate particular issues. For more about this topic, please see Promises and Pitfalls: Before and After Pictures.
 

For additional information, please see these related web pages:

 
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Dallas, TX 75231
(214) 363-2575
1105 North Central Expressway, Suite 2310
Medical Offices 2, Allen, TX 75013
(214) 509-0270
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Presbyterian Hospital of Dallas
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